Uroscopy
Does your doctor examine your urine — its color,
its cloudiness, its odor, and even its taste?
Not any more, unless you go to a quack who practices
what they believe to be medieval medical techniques.
But uroscopy was the primary medical "lab test"
from the 4th millennium BCE through the European Renaissance.
Hippocrates and Galen, the fathers of western medicine,
were keen practitioners of uroscopy.
That led to uroscopy's use in Byzantine medicine,
which led in turn to its adoption by Arab physicians and its spread
around the Mediterranean and into Europe.
Some of the ancient concepts were "re-discovered" from time to time
up to the 19th century.
You won't encounter uroscopy at your doctor's office,
but you might see it at the art museum.
Origins of Uroscopy
Physicians in Sumeria and Babylonia devised guidelines for uroscopy
as early as 4000 BCE.
The earliest medical prescriptions in Sumerian appeared
during the Third Dynasty of Ur, roughly 2112–2004 BCE.
The earliest Babylonian (that is, Akkadian) texts on medicine
date back to the first half of the 2nd millennium BCE,
during the First Babylonian dynasty.
Babylonian medicine reached its peak with the
Sakikkū
or the Diagnostic Handbook
written by Esagil-kin-apli of Borsippa,
the ummânū or chief scholar during the
1069–1046 BCE reign of Babylonian king Adad-Apla-iddina.
In parallel with ancient Egypt, Babylonian physicians introduced the concepts
of diagnosis, prognosis, physical examination, and prescriptions.
Classical Greek Uroscopy
The Greek physician Hippocrates (460–370 BCE)
theorized that urine was
a "filtrate" of the four χυμός,
or humors, of blood, black bile, yellow bile, and phlegm.
Galen then refined that theory to
urine being a filtrate only of blood.
They were quite influential, as this humorism, or theory of four
humors whose imbalance leads to disease, prevailed in European medicine
into the nineteenth century.
Asclepeion
on Kos
Greek island
toilets
Below is the
Ασκληπιείο
or
Asclepeion
on the island of
Κως or Kos.
It was dedicated to Asclepius, the first doctor-demigod in Greek mythology.
He was said to have been so skilled that he could
raise people from the dead.
Homer described him in the Iliad as a man,
a physician tending to soldiers injured at Troy.
By the time of Hippocrates, Asclepius had been elevated to godhood,
the descendant of the god Apollo and the mortal Coronis.
View from the Asclepeion to Kos town,
and across the water beyond that,
to Bodrum, Turkey.
These medical temples contained carefully designed and controlled spaces
conducive to healing.
One technique included incubation,
a religious practice of sleeping in a sacred space in the hope of
experiencing a divinely inspired dream that explained a cure.
A patient seeking admission into the Asclepeion first went
through katharsis, or purification —
cleansing baths, purgatives, and a cleansing diet,
for several days.
Meditation and chanting could help transition the patient
into a hypnotic state.
Some procedures may have occurred with the patient in a dream-like
state of induced sleep called
έγκοίμησις
or enkoimesis, a state similar to anesthesia,
induced with the help of opium.
To Arab Medicine, and Back to Europe
The Classical Greek knowledge passed to the Byzantine Empire,
and from there to the Arabs.
Theophilus Protospatharius or
ϴεόφιλος
Πρωτοσπαθάριος
was a Byzantine physician who wrote several medical works, probably during
the 7th century but we're not sure.
He's well known for his treatise
Περὶ
Οὔρων
or Peri Ouron,
known in Latin as De Urinis,
or "About Urine."
That's right, an entire book "About Pee".
Here is the pee-obsessed Theophilus examining a flask of urine,
as depicted in the Cockerell psalter of Oxford in 1250,
an uncertain number of centuries after his life.
Theophilus Protosphatharius shown in the Cockerell psalter of 1250, from
Wikimedia.
Meanwhile, Europe fell into the Dark Ages
while Arab science and medicine flourished.
Constantine the African, an 11th century physician,
brought medical knowledge back to Europe.
He traveled through Babylon, India, and Ethiopia, learning the local
science and medicine.
Then he compiled a vast collection of medical writings,
mostly translations from Byzantine and Arabic sources.
He translated the great masters of Arabic medicine into Latin —
Razes, Ibn Imran, Ibn Suleiman, Ibn al-Jazzar, and others.
His translations were used as medical textbooks across Europe
through the seventeenth century.
People showing their urine to the physician Constantine the African.
This is from a 14th century parchment document in the
Bodleian Library collection,
MS. Rawl. C. 328, image from
Wikimedia.
Constantine's translations and the Byzantine interpretations of ancient Greek
uroscopy were further spread by French physicians.
One was Gilles de Corbeil, a French royal physician born around 1140,
who wrote a
352-verse poem De Urinis
based on the treatise by
the Byzantine physician Theophilus Protospatharius.
Yes, another "About Pee",
this time in the form of a poem.
A later proponent of Constantine's translations was Bernard de Gordon,
a physician and professor at the University of Monpellier
in southeastern France from 1285 into the early 1300s.
Uroscopy Glassware — The Matula and Jordan
Both alchemists and physicians used a clear glass flask called a
matula in Latin.
It had a roughly spherical bulb and a narrower cylindrical neck.
Physicians used it to diagnose a patient by visually examining their urine.
The Old English term was
iurdan or
iurdane,
changing to
iurdone
in Middle English, when Gregory Chaucer used it.
It became
yordan or
iourden
through the 1500s,
then to
jordan.
Cover of The Urinal of Physick
by Robert Recorde, 1548, image from
Google Books.
The Welsh physician and mathematician Robert Recorde described a proper
matula or jordan in his book
The Urinal of Physick
in 1548.
Recorde described a proper matula or jordan:
...shulde be of pure clere glasse, not thyck, nor green in colour,
without blottes or spots in it, not flat at the bottom, nor too wyde
in the necke, but widest in the myddell, and narrow styll towarde
both endes, like the facyon commenly of an egg, or of a very bladder
beying mesurably blowen (for the Vrinall should represent the bladder
of a man) and so shall every thyng be sene in his dew place and coloure.
Recorde had been a Fellow of All Souls College at Oxford,
then studied medicine at the University of Cambridge.
He had served as physician to King Edward VI and to Queen Mary.
But then he was sued for defamation by a political enemy,
arrested for debt, and died in the King's Bench Prison, Southwark.
Judging by Sir Thomas Wriothesley's drawing of the deathbed of
King Henry VII in 1509, uroscopy was a popular medical test.
Three physicians holding pee bottles stand around the king's bed.
The deathbed of Henry VII in 1509, as drawn by Sir Thomas Wriothesley.
From the left on the near side of the bed are:
a physician holding a urine bottle,
William FitzWilliam holding a staff and closing the King's eyes,
a physician holding a urine bottle,
Hugh Denys, the Groom of the King's Close-Stool,
William Tyler,
and another physician holding a urine bottle.
Image from
Wikimedia.
Here's the Duke of Normandy in bed with physicians examining his pee.
Medical texts explained uroscopy.
Here's Robert Fludd's
Integrum Morborum Mysterium
from 1631.
Uroscopy By Color
Here is a uroscopy color wheel created by Ulrich Pinder in 1506.
It is from a book titled
Epiphanie medicorum. Speculum videndi urinas hominum. Clavis aperiendi portas pulsuum. Berillus discernendi causas et differentias febrium.
"Keys to open the gates of pulses", "The distinction between
the different kinds of fevers", and so on.
Toilets in Shakespeare's Time
The Folger Library in Washington, D.C., the largest collection of
Shakespeare material
in the world, has a copy of Ulrich Pinder's Epiphanie medicorum.
The recent development of printing meant that books had suddenly become
far more available.
Well to do people could own books, they were no longer restricted
to churches and medical professionals, and they might be written
in the local language instead of Latin.
Uneducated "healers" began selling the service of diagnosing ailments
based on urine color alone.
Of course, these books were usually printed with black ink only,
with color added by hand to a few pages.
But the colors weren't accurate to start with,
and soon faded or shifted in hue.
By the 17th century, the writer Thomas Brian published a criticism
of the "pisse prophets" profession.
Here is a page from Pinder's book.
And, from the same work, a two-column table of urine colors.
The following uroscopy color wheels are from a medical treatise
largely written by Richard Stapleton, Master of Balliol College,
Oxford University, around 1430.
It's
Manuscript Digby 29
at the Bodleian Libraries at Oxford.
MS. Digby 29, 129 recto.
MS. Digby 29, 129 verso.
MS. Digby 29, 130 recto.
Uroscopy in Literature
In William Shakespeare's Henry IV, Part 2,
Falstaff has had a physician examine his urine.
Enter FALSTAFF, with his PAGE bearing his sword
and buckler (and chamber pot)
FALSTAFF:
Sirrah, you giant,
what says the doctor of my water?
PAGE:
He said, sir, the water itself
was a good healthy water, but, for the party that
owed it, he might have more diseases
than he knew for.
— Henry IV Part 2, Act 1, Scene 2
Falstaff and his page with Falstaff's chamberpot and urine,
from
The Hollow Crown.
The makers of the miniseries had the page bring the urine back,
instead of simply relaying the results.
Christopher Marlowe wrote a two-part play
Tamburlaine the Great,
loosely based on the life of the
Central Asian emperor Timur (called "the Lame").
Timur lived 1336–1405.
Marlowe, who lived 1564–1593, wrote the play in 1587 or 1588.
It was one of the first successes of the London public stage.
Timur was a popular figure in Europe for centuries after his death,
mainly because he had defeated the Ottoman Sultan Bayezid.
Ottoman armies were invading eastern Europe, and western Europe
saw him as the enemy of their enemy.
Timur contracted an illness during a winter campaign and died in February 1405.
His body was taken to Samarkand and buried in an elaborate tomb,
the Gūr-e Amīr, which still stands.
In Marlowe's telling, Timur underwent uroscopy shortly before dying.
Marlowe had described Timur as:
...scourge and wrath of God,
The only fear and terror of the world.
In the last scene of the two-part play,
Timur is being attended by a group of physicians.
He commands his armies to wage unending war against the deities
that have disturbed his health:
Shall sickness prove me now to be a man
That have been termed the terror of the world?
Techelles and the rest, come take your swords
And threaten him whose hand afflicts my soul;
Come, let us march against the powers of heaven,
And set black streamers in the firmament,
To signify the slaughter of the gods.
Ah friends, what shall I do? I cannot stand.
Come, carry me to war against the gods.
2.5.3.44–52
Timur asks a physician what he thinks about his condition.
The physician replies with an analysis based on Timur's
urine and its hypostasis or sediment:
I view'd your urine, and the hypostasis,
Thick and obscure, doth make your danger great.
Your veins are full of accidental heat
Whereby the moisture of your blood is dried:
The humidum and calor, which some hold
Is not a parcel of the elements
But of a substance more divine and pure,
Is almost clean extinguished and spent;
Which, being the cause of life, imports your death.
2.5.3.82–90
Going back to Recorde's 1548
The Urinal of Physick,
then the dominant European text on uroscopy, we find Recorde telling
us that "thick and obscure" or black urine was the worst.
Now as for blacke, I nede not to speake any whyt; for as all men doo know hit,
so these letters do shew it / which though of all other hit be the most
dedlye, yet is hit surely of all the most myghty: for hit ouer cumyth all
coloures, & non can chaunge hit: so that well yt may be called the
colour of death.
For as death ouercummyth all bodyes, so black doth dampne all colours:
besyde that it is the messenger token of death, which is the ende of
all thinges, and blacke the end of colours.
Hippocrates had said "In all adult men and women the black is of
all kinds of urine the worst."
Galen agreed.
Black urine is like Timur.
He killed "Without respect of sex, degree, or age",
and so does black urine.
Chapter 11 of
Fecal Matters in Early Modern Literature and Art: Studies in Scatology,
titled "Tamburlaine's Urine", has the details.
Uroscopy in Film
The Ridley Scott film
The Last Duel,
set in the 1380s, contains a uroscopy scene.
First, swirl the urine flask in the light from the window.
Next, carefully compare it to the reference color chart.
Finally, discuss the findings with the patient.
Uroscopy in Art
Uroscopy was a surprisingly popular subject for painters.
A physician-alchemist examining a urine flask
by David Teniers the Younger (1610-1690)
Here is The Dropsical Woman, painted in 1663
by the Dutch painter Gerrit Dou (1613-1675),
from the Musée du Louvre in Paris.
I saw it when it was on loan to the National Gallery of Art
in Washington in 2017.
The physician is holding a matula to the light
to examine her urine.
In The Medical Alchemist, Franz Christoph Janneck (1703–1761)
depicts uroscopy.
The main figure is holding a flask up to the light, inspecting urine.
He wears a physician's red cap with fur trim.
There is a cabinet of glassware in the background, but he is resting his
arm on an open astrological reference.
He looks poorly dressed, with a scruffy beard.
There is a small Turkish carpet on his table, but it is frayed.
This painting was completed in the mid 1700s, when reputable physicians
no longer practiced astrological medicine.
The intent was probably to portray him as outdated at best,
or even a quack or charlatan.
"The Medical Alchemist" by Franz Christoph Janneck (1703-1761).
The End of Uroscopy
As late as 1882 the
Hand book of uroscopy
was published by Sumner Gleason as a medical text.
It informs us that
almost colorless urine indicates neuroses,
pale urine indicates a certain amount of anæmia,
dirty green urine indicates jaundice, and
dirty blue urine means cholera or typhus fever.
Patients with leprosy have dark red urine,
and when they're about to die it becomes dark brown.
If you absorb iron, logwood, carbolic acid, or tar into your system,
it can turn your urine black.
If you drink turpentine, it gives your urine an odor of violets.
After the rather traditional opening chapter,
it does get into chemical testing procedures.
Next article:
İstanbul: Sludge Surveillance and Sea Snot
